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DPU: INTERDISCIPLINARY CONFERENCE
Year : 2020  |  Volume : 7  |  Issue : 5  |  Page : 88-90

Effectiveness of carpal tunnel syndrome management by the combination of physiotherapy and homeopathic remedies as compared to physiotherapy treatment alone: A clinical study


Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil College of Physiotherapy, Pune, Maharashtra, India

Date of Web Publication26-Feb-2020

Correspondence Address:
Mrudula Vinayak Sangaonkar
Flat No. 1, RH95/4, Ganaraj Housing Society, Shahunagar, Chinchwad, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_56_19

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  Abstract 


Background: Several studies have shown that carpal tunnel syndrome (CTS) is a condition that reduces the functional activities of daily living due to pain and paresthesias. Primary approaches for the treatment of CTS include electrotherapy, splinting steroid injections, and decompression surgeries. The compression of the median nerve is treated with various remedies in single; very few researches are available in combination with different approaches. Aim: The study aimed to evaluate the effectiveness of CTS management by the combination of physiotherapy and homeopathic remedies as compared to physiotherapy treatment alone. Methodology: Thirty participants fulfilling the inclusion criteria were recruited and randomly divided into two groups: Experimental Group A received median nerve gliding exercises, tendon gliding exercises (3 sets and 10 repetitions, twice daily), and Hypericum perforatum medicine (4 pills once daily, before breakfast) for 10 days and control Group B received median nerve gliding exercises and tendon gliding exercises (3 sets and 10 repetitions, twice daily) for 10 days. Pre- and post-pain score was measured using the Visual Analog Scale (0–10). Results: Within group comparison showed a statistically significant decrease in pain with P < 0.05, but there was no statistically significant difference when compared between the experimental and control groups for pain reduction. Conclusion: The effectiveness of CTS management by the combination of physiotherapy and homeopathy remedies in reducing pain was the same when compared to physiotherapy treatment alone. There was no added benefit of homeopathy remedy.

Keywords: Carpal tunnel syndrome, homeopathy, nerve gliding exercises, pain


How to cite this article:
Sangaonkar MV, Palekar TJ, Choudhari GD. Effectiveness of carpal tunnel syndrome management by the combination of physiotherapy and homeopathic remedies as compared to physiotherapy treatment alone: A clinical study. J Dent Res Rev 2020;7, Suppl S2:88-90

How to cite this URL:
Sangaonkar MV, Palekar TJ, Choudhari GD. Effectiveness of carpal tunnel syndrome management by the combination of physiotherapy and homeopathic remedies as compared to physiotherapy treatment alone: A clinical study. J Dent Res Rev [serial online] 2020 [cited 2020 Jul 8];7, Suppl S2:88-90. Available from: http://www.jdrr.org/text.asp?2020/7/5/88/278897

Editor: Dr. Pradnya Kakodkar





  Introduction Top


The carpal tunnel is the space between the carpal bones dorsally and the flexor retinaculum volarly. The extrinsic finger flexor tendons and medial nerve pass through the tunnel. In this region, the median nerve is susceptible to pressure as it courses through the tunnel along with finger flexor tendons. The normal excursion of the median nerve at the wrist is 14 mm. Carpal tunnel syndrome (CTS) is described by the sensory loss and motor weakness that occur with the compression of the median nerve. Anything that decreases the space in the carpal tunnel or the contents of carpal tunnel gets enlarged will compress or restrict the mobility of the median nerve. The etiological factors can be local or systemic like synovial thickness, scarring of the tendon sheath or irritation, inflammation, and swelling as a result of repetitive wrist flexion, extension, and gripping activities. Awkward wrist postures, sustained compressive forces, and vibrations by the usage of machines can be the reasons for the compression of the median nerve. The common functional limitations and disabilities are as follows: decreased prehension in tip-to-tip, tip-to-pad, and pad-to-pad activities requiring fine neuromuscular control of thumb opposition. These limitations can occur in the area of the hand where there is decreased wrist motion, such as cashier checkout scanning, performing provoking sustained or repetitive line work, fine tool manipulation, typing, or manipulation of a computer mouse.

The symptoms occurring are the pain and paresthesias in the area of the median nerve distribution in the hand, weakness, or hypertrophy of the thenar muscles, leading to the difficulty in activities needing repetitive or prolonged flexion and extension.[1] The prevalence of CTS is 60% in females and 40% in males.[2]

The most commom conservative interventions in the management of CTS involves pain management and decreasing the symptoms of tingling, numbness and weakness. This is done by splinting, electrotherapy modalities and exercises. Operative management involves decompression surgeries. Physiotherapy treatment involves tendon gliding exercises, which have been used since 1990 and has a beneficial effect in achieving mobility and reduction in symptoms of median nerve compression.[1]

Alternatively, homeopathy also offers a great remedy for injuries to nerves, especially for the peripheral nerve injuries using Hypericum perforatum medicine.[3] Herpericum has specific action over injuries to the nervous system and muscular system. It has an action on reducing the inflammation in peripheral nerves in compression and laceration, etc.[4]

As against this background, the present study was designed to evaluate the effectiveness of CTS management by the combination of physiotherapy and homeopathy remedies as compared to physiotherapy treatment alone.


  Methodology Top


This was an experimental study with a sample of 30 participants. The study protocol was approved by the Institutional Ethics Committee (DYPCPT 86/4/10/2018). The samples for the study were selected according to the inclusion criteria: (age of the participant between 30 and 60 years, pain in the area of distribution of the median nerve, positive result for Phalen's test and Tinels sign, and those who were willing to give informed consent form). The exclusion criteria were cervical spondylosis, any trauma to the wrist, pregnancy, and rheumatoid arthritis. The participants were recruited from the physiotherapy outpatient department (OPD). The outcome measure is pain reduction using the Visual Analog Scale (VAS) (0–10). The participants were randomly divided into two groups: Experimental Group A received median nerve gliding exercises, tendon gliding exercises (3 sets and 10 repetitions, twice daily), and H. perforatum medicine (4 pills once daily, before breakfast) for 10 days and control Group B received median nerve gliding exercises and tendon gliding exercises (3 sets and 10 repetitions, twice daily) for 10 days. The exercises were taught to all the participants in the OPD and were instructed to perform the exercises at home. Baseline pain was measured for all the participants using the VAS. On the 11th day, the participants were called at the clinic, and the VAS was recorded again.

The collected data were analyzed statistically using the t-test. The level of statistical significance was fixed at P < 0.05.


  Results Top


Fifteen participants (6 males and 9 females) in Group A and 15 participants (5 males and 10 females) in Group B completed the study.

At baseline, overall, the VAS score ranged from 3 to 8. The mean pre-VAS score in Group A was 6.54 and post-VAS was 4.04, respectively. There was a statistically significant change in the pretreatment and posttreatment intensity of pain of 2.5, which was statistically significant at P < 0.05 [Table 1].
Table 1: Comparison of pre- and post-Visual Analog Scale scores in Group A

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The mean pre-VAS score in Group B was 5.96 and post-VAS was 3.13, respectively. There was a significant change in the pretreatment and posttreatment intensity of pain of 2.8, which was statistically significant at P < 0.05 [Table 2].
Table 2: Comparison of pre- and post-Visual Analog Scale scores in Group B

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The comparison of the difference (pre and post) in pain scores of Group A and Group B showed no statistically significant difference [Table 3].
Table 3: Comparison of mean differences of the Visual Analog Scale scores in Group A and Group B

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  Discussion Top


The present study was designed to evaluate the effectiveness of CTS management by the combination of physiotherapy and homeopathy remedies as compared to physiotherapy treatment alone. The results indicate that there was a statistically significant difference in the intensity of pain within the group, but there was no statistical difference in the intensity of pain between the groups posttreatment. This study showed that the combination of therapies or single therapy has the same pain-reducing effect. However, homeopathic remedy was not able to demonstrate any additional effect when combined with physiotherapy.

Literature reports that homeopathic remedy can reduce pain and inflammation. Boricke reported that H. perforatum is an effective remedy in treating the patients with peripheral nerve injuries, darting pain in the shoulders, cramps in the calf muscles, and pain in the tips of the fingers and toes.[3] Burt W studied herpericum and reported that it is effective in lacerated, compressed, and wounded nerves with excruciating pains.[4] Further, Robin Murphy also supported that this medicine is effective in the management of symptoms of pain and numbness in nerve compressions.[5]

The digital mobilizing technique is valuable in the management of CTS. Kim conducted a systematic review on the efficacy of tendon and nerve gliding exercises for CTS and found that the important exercises in treating the CTS are by mobilizing the median nerve and the finger flexor tendons.[6]

The study has a few limitations: It was a home-based study, and there was no supervision if the participants have really done the exercises and or taken medicines (in Group A). The outcome was assessed at the end of 10 days which maybe a short period and probably the longer assessment would have given different results. Objective outcome assessor was not used in the present study, which would have given valid results as compared to subjective which was used in the present study.

This study was not able to demonstrate the added effectiveness of the homeopathy remedy. However, it is recommended that further study be conducted of a longer duration overcoming the limitations of this study.


  Conclusion Top


The effectiveness of CTS management by the combination of physiotherapy and homeopathy remedies in reducing the pain was the same when compared to physiotherapy treatment alone.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kisner C, Colby LA. Therapeutic Exercise Foundationa and Techniques. 7th ed.; 2018. p. 405.  Back to cited text no. 1
    
2.
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282:153-8.  Back to cited text no. 2
    
3.
Boricke W. Pocket Manual of Homeopathic Materia Medica and Repertory. 9th ed.; 2010. p. 330.  Back to cited text no. 3
    
4.
Burt WH. Physiological Materia Medica. 3rd ed. B Jain Publisher; 2009. p. 474.  Back to cited text no. 4
    
5.
Murphy R. Lotus Material Medica. 2nd Revised ed. B Jain Publisher; 2003. p. 853.  Back to cited text no. 5
    
6.
Kim SD. Efficacy of tendon and nerve gliding exercises for carpal tunnel syndrome: A systematic review of randomized controlled trials. J Phys Ther Sci 2015;27:2645-8.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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